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As the world marks World Mental Health Day 2025, the conversation has turned to an urgent question: who receives care when disaster strikes? This year's theme - "Access to Services: Mental Health in Catastrophes and Emergencies" - underscores a sobering truth. When earthquakes, floods, wars, or pandemics unravel societies, the very systems that sustain mental health often collapse. For countries like Bangladesh, where climate disasters and displacement are recurring realities, the challenge of maintaining access to mental health care during crises has never been more immediate.
According to the World Health Organisation (WHO, 2025), over one billion people worldwide live with mental health conditions. Emergencies make these conditions worse. In conflict and disaster-affected areas, roughly one in five people suffer from depression, anxiety, post-traumatic stress disorder (PTSD), bipolar disorder or schizophrenia. Emergencies intensify these problems by amplifying trauma, grief, uncertainty, and loss, while simultaneously destroying the infrastructure and services designed to help.
When catastrophes hit, the physical destruction is apparent - broken homes, flooded villages, shattered schools. But the psychological wreckage is quieter and more enduring. Survivors face chronic stress, fear of recurrence, and social isolation. WHO studies show that the mental health impact of emergencies can persist long after physical recovery begins. Yet, funding and attention often fade once the initial humanitarian response ends.
Mental health experts describe this as the "second wave" of a disaster - the psychological aftershock. For example, after a flood or cyclone, people experience sleeplessness, panic attacks, and despair over lost livelihoods. Without timely intervention, such distress can evolve into severe disorders, including depression and PTSD. Unfortunately, access to support remains minimal.
Globally, humanitarian agencies acknowledge that mental health and psychosocial support (MHPSS) is one of the most underfunded areas of crisis response. The Inter-Agency Standing Committee (IASC), which coordinates UN humanitarian work, urges that psychosocial care should be built into the first phase of any emergency - not added later. Yet, the reality remains uneven.
Mental health care capacity worldwide was already stretched thin before the pandemic, and COVID-19 exposed the fragility of systems even in high-income nations. The WHO's 2024-25 Global Mental Health Report notes that less than 2 per cent of health budgets are allocated to mental health in low- and middle-income countries. In emergencies, this proportion often drops further.
The lack of trained professionals compounds the problem. Many countries have fewer than one psychiatrist per 100,000 people. In fragile or conflict-affected states, entire regions may go years without any specialised psychiatric service. Amid catastrophe, continuity of care for those already on treatment is disrupted - medications run out, clinics close, and people relapse.
For Bangladesh, the issue of mental health access is inseparable from geography and climate. The country ranks among the most disaster-prone nations on Earth, enduring annual floods, cyclones, river erosion, and salinity intrusion. These recurring shocks cause immense human suffering and contribute to the steady rise of psychological distress across communities.
WHO data suggest that Bangladesh has only about 260 psychiatrists - roughly 0.16 per 100,000 people - and around 565 psychologists serving over 170 million citizens. Most are concentrated in Dhaka and Chattogram, leaving rural and coastal districts underserved (Huque et al., 2025; WHO, 2024). For millions, mental health support is effectively out of reach.
Emergencies magnify this inequity. When the 2024 flash floods swept through Sylhet and Cumilla, displacing tens of thousands, humanitarian responders noted a surge in trauma, anxiety, and grief among survivors. A study by Rahman et al. (2025) found that symptoms of depression and anxiety were nearly double among flood-affected populations compared to unaffected groups. However, only a small fraction of those affected received professional psychosocial support, due mainly to the absence of services outside urban centres.
The Rohingya refugee camps in Cox's Bazar are a mirror of both human resilience and systemic strain. Over one million refugees live in one of the world's most densely populated humanitarian settlements. Here, emergencies never truly end - fires, landslides, disease outbreaks, and food insecurity are recurrent threats.
According to UNHCR (2024), while millions of consultations are conducted for physical ailments in the camps, specialised mental health services remain critically limited. Many refugees suffer from long-term trauma, depression, and anxiety after years of displacement. Children and adolescents are particularly vulnerable, showing high rates of behavioural problems and distress. Despite dedicated community-based psychosocial initiatives, sustained clinical support and continuity of care remain elusive due to resource constraints and short-term funding cycles.
For the host communities surrounding the camps, the psychological toll is also mounting. Economic competition, resource scarcity, and environmental degradation have eroded social cohesion, leading to rising stress and frustration. Without expanded access to MHPSS, both refugee and host populations risk chronic psychological harm.
Bangladesh's climate vulnerability extends beyond natural disasters to the slow-onset emergencies that wear down wellbeing over time. Increasing heatwaves, erratic rainfall, and salinity intrusion disrupt agriculture, food security, and livelihoods - critical social determinants of mental health. The World Bank (2025) estimated that rising heat caused economic losses of USD 1.78 billion last year alone. Such losses translate directly into psychosocial strain as families face uncertainty, debt, and migration pressures.
Research led by Stanford University (2025) highlights how climate-induced distress - sometimes called eco-anxiety - is rising among young people in Bangladesh and other climate-vulnerable nations. Adolescents in flood-prone areas report feelings of helplessness and fear about the future. Without structured psychosocial support, these emotions can evolve into more severe mental health problems, affecting education and productivity.
Access to mental health care in emergencies cannot rely solely on psychiatrists or psychologists. The scale of need demands task-sharing - training non-specialist workers, community health volunteers, teachers, and religious leaders to provide basic psychological first aid and identify people who need advanced care.
This approach, supported by WHO's mhGAP (Mental Health Gap Action Programme), has already shown success in rural Bangladesh. Primary healthcare providers trained under mhGAP can diagnose and manage common mental disorders and refer complex cases to specialists. Expanding this model across disaster-prone districts could make care more resilient.
Equally important is integration - embedding MHPSS within national disaster preparedness and response frameworks. Psychosocial first aid, emergency stocks of essential psychotropic medicines, and tele-mental health services must be treated as core components of emergency response, not optional extras.
Digital tools are opening new possibilities. Tele-counselling services, mobile apps for stress management, and virtual supervision for remote health workers have expanded rapidly since the pandemic. If properly regulated for privacy and cultural appropriateness, these platforms can extend mental health support to remote coastal and char communities where no psychiatrist has ever served.
Funding remains the defining barrier. Mental health accounts for less than 1 per cent of Bangladesh's total health budget. During disasters, the allocation for psychosocial care is often symbolic. Yet, the WHO's mental health investment case for Bangladesh (2024) shows that every dollar spent on scaling up mental health interventions can yield a return of four dollars in improved health and productivity. The logic is straightforward: stable mental health helps rebuild livelihoods, sustain education, and reduce social conflict.
Donor agencies and NGOs have contributed significantly to humanitarian MHPSS programmes, but most operate on short-term grants that end once the immediate crisis passes. The government must therefore institutionalise MHPSS financing within both health and disaster management budgets. A multi-year funding stream - linked to the Ministry of Health and Family Welfare's National Mental Health Strategy (2024-2030) - would allow continuity of services and workforce expansion.
To ensure that access to mental health care survives a catastrophe, Bangladesh needs a three-tiered strategy. First, decentralisation - bringing mental health services closer to people. This means scaling up mhGAP training for rural clinics, stocking essential medicines in upazila hospitals, and linking local providers to national experts through tele-supervision.
Second, preparedness - embedding MHPSS into national disaster response. Emergency stockpiles of psychotropic drugs, rapid-deployment psychosocial teams, and clear referral systems can ensure continuity of care even amid chaos.
Third, sustainability - integrating mental health into long-term development plans, climate adaptation policies, and education systems. Mental well-being must be recognised as part of human capital - not as a luxury for the few.
As the theme of World Mental Health Day 2025 reminds us, access to mental health care during catastrophes is not merely a technical challenge; it is a measure of humanity. The capacity to sustain care amid chaos reflects whether societies view mental well-being as a right or a privilege.
The humanitarian and climate emergencies of our time are not passing storms - they are structural realities. As the ground shifts under our feet, mental health services must become part of the bedrock of resilience. Access to care cannot depend on whether a hospital survives the next cyclone or whether an NGO secures another grant. It must be guaranteed by design, embedded in policy, and protected by sustained investment.
Bangladesh has shown the world how to reduce cyclone deaths through early warning systems and community preparedness. The same determination can now be applied to protecting mental health. Every disaster is also a test of compassion, and every act of care is an act of rebuilding.
Dr Matiur Rahman is a researcher and development professional.